Thursday, May 21, 2015

Nearly 500 Dentists in 4 States bill Medicaid for almost $175 Million

Dentists Charged Taxpayers $175M For Unneeded Work On Kids

Ethan BartonMay 18, 2015

Nearly 500 dentists in four states billed Medicaid almost $175 million for potentially fake, unneeded or shoddy work on kids in 2012, a government watchdog reported Monday.

Investigators most recently caught 335 California dentists who sent $117.5 million of questionable bills to Medicaid, the Department of Health and Human Services inspector general reported. The watchdog caught another 151 dentists in New York, Louisiana and Indiana over the last year, who billed Medicaid $56.1 million in 2012.

“In recent years, a number of dental providers and chains have been prosecuted for providing unnecessary dental procedures to children with Medicaid and causing harm in the process,” the report said. “A concentration of providers with questionable billing in chains raises concerns that these chains may be encouraging their providers to perform unnecessary procedures to increase profits.

The 335 providers, which make up 8 percent of all California dentists, served more than one-third of all the Medicaid children investigators reviewed.

Also, 229 of the California dentists performed at least 76 total services for children on average per day – more than triple the state average of 24. In fact, one dentist averaged more than 500 services per day, while another averaged 862, investigators reported.

Services include work such as cleanings, taking x-rays or filling a cavity.

One dentist provided more than 1,000 services per day on 97 different days.

“One day, he provided 1,658 services,” the report said. “If this dentist spent only five minutes performing each service, it would have taken over 138 hours to complete all of these services.”

Another dentist “provided 33 services to a 4-year-old child during a single visit,” the report said. “These services included 13 stainless steel crowns” and 11 [baby root canals].”

Nearly 130 dentists also provided a high number of specific services. Investigators reported that 108 dentists gave stainless steel crowns to at least 18 percent of their pediatric patients – more than triple the average proportion – for example.

Another nine dentists gave at least 15 baby root canals in a single visit to 15 different kids aged between 3 and 5 years old. Children that young have only 20 teeth, according to the Tennessee Department of Health.

“If these services were actually provided, it raises concerns about quality of care and whether these children were harmed,” investigators said.

Further, seven dentists pulled teeth from eight out of ten children they served, while one extracted at least one tooth from 98 percent of his pediatric patients, the inspector general reported.

Investigators noted that 12 of the dentists had already been disciplined by California’s dental board for shoddy work. One dentist, for example, was put “on probation for five years for erroneously sedating, overdosing and failing to adequately monitor a 5-year-old child,” the report said.

Additionally, half of the 335 dentists worked for dentistry chains. Two of those chains “have been the subject of state and federal investigations,” the report said.

The report was the fourth in a series investigating questionable billing for pediatric dental services in 2012.

Previously, the inspector general found 29 New York dentists potentially defrauded Medicaid for $13.2 million.

Another report found 27 Louisiana dentists sent $12.4 million of questionable bills to Medicaid.

A third report found 95 Indiana dentists may have fraudulently billed Medicaid $30.5 million.

(28 % worked for Kool Smiles)

A large number of these dentists worked for only a few chain practices.

The inspector general will follow up and “will take action against these providers, as appropriate,” the report said.

Medicaid is the primary source of dental coverage for children in low-income families and provides dental care for around 37 million kids.